Retrosternal goiter located in the mediastinum: surgical approach and operative difficulties

Kacprzak, Grzegorz; Karaś, Jacek; Rzechonek, Adam; Błasiak, Piotr

doi:10.1093/icvts/ivs339

Cited by 17 publications

(22 citation statements)

References 4 publications

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“…RSG is usually contained within the anterior mediastinum, however, posterior mediastinal RSG occurs in 10-15% of cases [6]. Most RSG can be managed through a cervical incision although it has been suggested that RSG with a large proportion of mass in the posterior mediastinum carry a higher risk of sternotomy which is more technically challenging and traumatic [7].…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Retrosternal Goitre

Welman

Heyes

Dalal

et al. 2017

Indian J Otolaryngol Head Neck Surg

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This study aims to evaluate surgical approaches to the management of retrosternal goitre. Between 2004 and 2014, 35 patients (eight males; mean age 67.4 ± 10.9 years) with retrosternal goitre (mainly right-sided in 9, left-sided in 14 and bilateral in 12) underwent surgery. A palpable neck mass was found in 11 (31.4%), stridor in 10 (28.6%) and thyrotoxicosis in 4 (11.4%) cases. 4 (11.4%) patients were asymptomatic. Tracheal compression was detected radiologically in 27 (77.2%) patients with deviation in 18 (51.4%). A collar incision was performed in 34 patients, 6 (17.1%) of whom required additional sternotomy, 1 (2.9%) was assisted by an anterior mediastinotomy. 1 (2.9%) had a right lateral thoracotomy. There was no operative mortality. Transient vocal changes occurred in 3 (8.6%) patients, recurrent laryngeal nerve palsy in 3, atrial fibrillation in 2, and wound complications in 2 (5.7%). Hospital stay ranged from 2 to 12 days (5.5 ± 2.0). Multinodular goitre was found in 33 patients, diffuse goitre in 1 and ectopic thyroid in 1. The average vertical length of goitres in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. The average weight of specimens was 156.3 g in patients with collar incisions and 307.5 g in the sternotomy group. Removal of retrosternal goitre is more commonly performed via a cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the risk of sternotomy. Surgical outcomes are not affected by surgical approach.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Retrosternal Goitre

Welman

Heyes

Dalal

et al. 2017

Indian J Otolaryngol Head Neck Surg

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“…3 of these cases (50%) developed hypoparathyroidism after a form of sternotomy. Still malignant transformation is equivalent in RG to those residing entirely in the neck [17].…”

Section: Discussionmentioning

confidence: 99%

Surgical Approaches to Retrosternal Goiter, When Sternotomy Is Mandatory? National Cancer Institute Experience (NCI), Cairo University, Egypt

Fathalla¹,

Ahmed²

2016

JCT

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Background: Retrosternal goiters (RG) are those lesions extending to occupy the thoracic cavity. They carry a surgical risk due to distorted anatomy, the minimal access, and the potential for great vessels or pleural injury. No other effective therapeutic alternative to surgery exists. Cervicotomy is still the surgical approach of choice, although a form of sternotomy may always be necessary for field extension and safe gland delivery. Materials and Methods: This is a single institution combined retrospective & prospective study including retrospective analysis of all cases presenting to the NCI, Cairo University with RG candidate for surgery between Jan. 2008 until the end of Dec. 2012, and a prospective study of all cases with the same presentation presenting to the NCI between Jan. 2013 until the end of Dec. 2015. Data was collected from archive of patients at the statistical department. Aims: To study the clinico-pathological characteristics, the presentation, workup, surgical approaches and postoperative complications of RG. Results: 42 patients were included & were divided into benign (34 patients, 80.9%) and malignant groups (8 cases, 19.1%). All patients (100%) were adults ranging (19 to 73 years) with mean 53.1 years. There was a female predominance (36 female, 85.7%) versus (6 males, 14.3%). Median duration of symptomatology was 23 months ranging (6-53 months). 23 patients (54.7%) were symptomatic while 19 cases (45.3%) accidently discovered. Mean tumor size was 9.97 cm in the benign group and 11.1 cm in the malignant group. 31 patients (73.8%) were euthyroid, 9 (21.4%) were thyrotoxic and 2 (4.7%) were hypothyroid. All patients (100%) underwent total thyroidectomy. The commonest approach was cervicotomy (33 cases, 78.6%), while a type of sternotomy was done in 9 cases (21.4%). 2 cases (4.7%) received postoperative radiation therapy & 4 cases (9.5%) received postoperative radioactive iodine. No perioperative mortality occurred & the overall morbidity was 6 cases (14.2%) in the benign group and 2 cases (4.7%) in the malignant group (4.7%). The median follow up period was 17.5 months. The median overall survival (OS) was 39.4 months and A. El Sayed Fathalla, B. El Din Ahmed 312 the median disease free survival (DFS) was 9.8 months for the malignant group. Conclusion: Cervicotomy is a safe favorable approach to remove a RG. Intraoperative field extension up to a form of sternotomy may be necessary for gland delivery with increasing operating time, hospital stay and morbidity. Postoperative morbidity is mainly due to the respiratory, recurrent laryngeal nerve palsy and hypoparathyroidism which is mainly increased when sternotomy is performed.

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“…Although the majority of these goiters are amenable to transcervical thyroidectomy, a minority of patients may require sternotomy or thorachotomy extending into the posterior mediastinum and retrovascular space. However, overall number of complications associated with this approach is higher than that seen with the transcervical approach 4 . Lateral thoracotomy cannot achieve good exposure for bilateral posterior retrovascular, recurrent goiter and especially their malignant forms.…”

Section: Introductionmentioning

confidence: 96%

“…However, overall number of complications associated with this approach is higher than that seen with the transcervical approach. 4 Lateral thoracotomy cannot achieve good exposure for bilateral posterior retrovascular, recurrent goiter and especially their malignant forms. Another advantage of sternotomy is that during any vascular injury surgeon can easily control this problem and if necessary can start cardiopulmonary bypass.…”

Section: Introductionmentioning

confidence: 99%

An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report

Aziret

Topcuoglu

Özçelik

et al. 2014

International Journal of Surgery Case Reports

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INTRODUCTIONSurgical treatment of benign thyroid diseases need to be followed up closely, since recurrent thyroid nodules can be seen after subtotal thyroidectomy. Intrathoracic goiter (ITG) occurs in 10–30% of patients following subtotal thyroidectomy. In general these goiters are benign, having a malignant rate of only 2–22%. ITG grows slowly but steadily and in its process of development, it narrows the thoracic inlet by compressing the surrounding structures. Most of these can not located in the anterior mediastinum, others located in posterior retrovascular area. Bilateral posterior retrovascular goiters are very rare.PRESENTATION OF CASEWe report a case involving a 61-year-old woman with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. She had undergone bilateral thyroid lobectomy for a cervical goiter 10 years ago. The mass was removed successfully via median sternotomy without complication. The patient recovered well and was discharged in 1 week.DISCUSSIONMost anterior mediastinal goiters can be resected through a transcervical approach, but if those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy.CONCLUSIONBilateral recurrent posterior mediastinal and retrovascular large goiters are better resected via sternotomy rather than lateral thoracotomy. The reason for that are the possibility of injury to large vascular structures and the difficulty of their management through lateral thoracotomy when cardiopulmonary bypass needed.

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Retrosternal goiter located in the mediastinum: surgical approach and operative difficulties

Cited by 17 publications

References 4 publications

Surgical Treatment of Retrosternal Goitre

Surgical Treatment of Retrosternal Goitre

Surgical Approaches to Retrosternal Goiter, When Sternotomy Is Mandatory? National Cancer Institute Experience (NCI), Cairo University, Egypt

An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report

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